Predictive Factors for Successful Vaginal Delivery after a Trial of External Cephalic Version: A Retrospective Cohort Study of 946 Women.

OBJECTIVE: Our aim was to find the factors which predict a vertex presentation of vaginal delivery (VD) in women who are admitted for a trial of external cephalic version (ECV). STUDY DESIGN: This is a retrospective cohort study of women who underwent a trial of ECV and delivered between November 2011 and December 2018 in a single tertiary center. The main outcome measure was successful VD of a fetus in the vertex presentation. Women who achieved VD in the vertex presentation or underwent cesarean delivery were compared on the basis of variety of predictive factors. Adverse neonatal and maternal outcomes were reported. Logistic regression was used for the multivariate analysis. RESULTS: A total of 946 women were included; 717 (75.8%) women had a successful ECV and 663 (70.1%) women had a VD in the vertex presentation. Parous women had 79.3% VD rate (570/719) and nulliparous women had 41.0% VD rate (93/227). Women with an amniotic fluid index (AFI) of 50 to 79, 80 to 200, and >200 mm had 34.8, 71.0, and 83.1% VD rate, respectively. Parous versus nulliparous women had an adjusted odds ratio (aOR) of 5.42 (95% confidence interval [CI]: 3.90-7.52, p < 0.001), women with AFI 50 to 79 mm compared with AFI 80 to 200 mm had an aOR of 0.21 (95% CI 0.12-0.37, p < 0.001), and women with an AFI >200 mm compared with AFI 80 to 200 mm had an aOR of 1.74 (95% CI: 1.03-2.92, p = 0.037) to achieve VD. The final prediction model for the chances of a VD based on data on admission for ECV was reported. The Hosmer-Lemeshow test was used to evaluate the goodness of fit of the model (p = 0.836). CONCLUSION: Being parous and having an AFI >200 mm are positive independent predictive factors for achieving VD of a vertex presenting fetus after ECV. Whereas AFI 50 to 79 mm is a negative independent predictive factor. KEY POINTS: · The goal of ECV is to achieve a vertex VD.. · Predictors for ECV success might not predict a VD.. · Parity & AFI independently predict a VD after ECV..

Does the presence of symptoms affect pregnancy outcomes in third trimester in women with SARS-CoV-2.

OBJECTIVE: Parturients with symptoms to COVID-19 have an increased risk for neonatal adverse outcomes and for any adverse outcome compared to the asymptomatic COVID-19 positive parturients and to the COVID-19-negative parturients. The purpose of this study was to determine the effect of COVID-19 on obstetric outcomes based on symptom status of parturients at or near term. METHODS: Retrospective cohort study of parturients diagnosed with COVID-19 between 26 March and 30 September 2020. Maternal and neonatal outcomes were assessed by comparing three groups of parturients: COVID-19 negative, asymptomatic COVID-19, and symptomatic COVID-19. RESULTS: A total of 2299 COVID-19-negative parturients and 172 patients with confirmed diagnosis of COVID-19 delivered during the study period. The median gestational age at the time of delivery was 39 (interquartile range 39-40) weeks. The most common symptom was cough (28/56, 50%). Gestational diabetes mellitus was significantly less common in COVID-19-negative than in COVID-19-positive patients. There was no significant increase in cesarean delivery in women who were COVID-19 positive and the incidence of preterm deliveries was not significantly different among the three groups. Of the 172 cases of COVID-19, only one parturient needed mechanical ventilation, and there were no maternal deaths in this group. There were no cases of severe neonatal asphyxia or neonatal death. Composite maternal adverse outcomes were not significantly different between the three groups. The aOR for composite neonatal adverse outcome and overall composite adverse outcome comparing COVID-19 positive to negative parturients was 2.1 (95% confidence interval [CI], 1.1-3.8; p = .02) and 1.6 (95% CI, 1.1-2.3; p = .02), respectively. CONCLUSIONS: An increased risk for neonatal adverse outcomes and for any adverse outcome was found in the symptomatic COVID-19 group compared to the asymptomatic COVID-19-positive parturients and to the COVID-19-negative parturients.

Is vaginal delivery of a breech second twin safe? A comparison between delivery of vertex and non-vertex second twins.

AIM: The aim of this study was to determine the safety of vaginal delivery with a non-vertex second twin when the first twin is in the vertex presentation. MATERIALS AND METHODS: A retrospective analysis was undertaken, utilizing a cohort of twin gestations in which the presenting twin was vertex and the second twin was either vertex (group A) or non-vertex (group B). We assessed maternal and neonatal outcomes including emergency cesarean delivery, 5-minute Apgar scores, cord arterial pH, NICU admissions, and adverse maternal postpartum outcomes including ICU admissions and the requirement of blood products. RESULTS: Six hundred and eighty-five women with a vertex presenting twin were admitted to labor and delivery. Three hundred and ninety-five women were included in group A (vertex/vertex) and 290 were included in group B (vertex/non-vertex). No statistically significant differences were found in the 5-minute Apgar scores, cord arterial pH, or in the rates of emergency cesarean deliveries, NICU admission, maternal blood transfusion or ICU admissions. CONCLUSION: In conclusion, vaginal delivery of a breech second twin when the presenting twin is vertex was found as safe as vaginal delivery of twins in the vertex/vertex presentation.

Is Laser Assisted Capsulotomy better than standard CCC?

Objectives: To compare the safety and intraoperative difficulties of two capsulorhexis techniques for white intumescent cataract: Femtolaser-assisted capsulorhexis and manual capsulorhexis performed in 2-3 stages, with the Utrata forceps. Materials and methods: A prospective comparative study that included 28 eyes divided into 2 equal groups in which capsulorhexis was performed by using the 2 methods. In the first group, the capsulorhexis was executed by using LenSx Femtolaser. In the second group, an Utrata forceps was used to perform a manual 2-3 steps capsulorhexis as follows: a small 2-3 mm capsulorhexis was performed after the staining of the anterior capsule with Trypan Blue along with a good pressurization with viscoelastic substance. The liquefied cortex was aspirated, followed by the enlargement of the capsulorhexis. In some cases, the enlargement was made after IOL implantation. Results: In the Femtolaser group, the capsule was completely detached in 13 cases and only in one case, the capsule had a few bridges which detached easily, without endangering the capsulorhexis integrity. Its size was 4,9 mm in all cases. In the group in which capsulorhexis was performed with the Utrata forceps in 2-3 stages, this was complete, circular and relatively well centered in all cases, but the size varied between 4,5 and 5,5 mm. Conclusions: Femtosecond laser-assisted capsulorhexis was round, well centered and of a desired size of 4,9 mm. The manual capsulorhexis with the Utrata forceps depends on the surgeon's skill and experience and requires a good local anesthesia, the coloring of the anterior capsule with Tripan Blue, using a large quantity of cohesive viscoelastic substances and sometimes using micro incision forceps for helpful maneuvers. The size and centering of the capsulorhexis are not always identical with the intended ones.

IRIDEX MicroPulse P3: innovative cyclophotocoagulation.

Purpose: To present the new IRIDEX MicroPulse P3 (MP3) technology in patients with refractory glaucoma and our preliminary results at 1 week and 1 month postoperatively. Methods: IRIDEX MP3 laser cyclophotocoagulation was performed in 7 eyes of 7 patients under retrobulbar anaesthesia with lidocaine 2% in the operating room. Each eye received two treatments of 80-90s over the superior and inferior hemisphere, avoiding the temporal- and nasal-most clock hours. 810nm IRIDEX MP3 was set to 31,3% duty cycle (0,5ms treatment pulse followed by 1,1 ms of rest). Postoperative topical steroids were prescribed for 1 week. Results: Mean IOP decrease at 1 week was 60,3% and 33,4% at 1 month, with a mean topical hypotensive treatment reduction of 0,71 therapeutic agents. The procedure was safe in all cases and effective in 71% of the patients. Neovascular glaucoma patients registered high IOP levels 1 month postoperatively in spite of medical and MP3 laser treatment. BCVA remained unchanged after undertaking the laser procedure. No significant inflammation, discomfort, or pain was reported. There were no complications such as hypotony, phthisis bulbi, and macular edema. Conclusions: IRIDEX MP3 represents an innovation in cyclophotocoagulation. It is non-destructive, repeatable, non-invasive, with a high safety profile. A mean IOP decrease of 33,4% was registered at 1 month. Patient comfort and recovery are favorable. Long-term results will prove its efficacy in the future.

Viable triplet pregnancy coexisting with a complete molar pregnancy.

This case is extraordinary because it was never before described in English literature. The case describes a long-standing debate about the safety of carrying this pregnancy to term. Some authors are for and some are against. The risks and benefits should be thoroughly reviewed before a decision is made.

THE ADVANTAGES OF FEMTOSECOND LASER-ASSISTED CATARACT SURGERY.

PURPOSE: To present the advantages of performing femtosecond laser-assisted (Alcon-LenSx Inc.) cataract surgery. METHODS: Cataract surgery was performed with the LenSx femtosecond laser (Alcon-LenSx Inc.) in 50 eyes of 50 patients. The laser was programmed to perform a 4,9-4,5 mm capsulorhexis, a 2,3 mm main corneal incision, two 1,3 mm side-port incisions and either a hybrid-pattern or a cylinder-pattern fragmentation of the nucleus. The evaluated parameters were the capsulotomy, the corneal wounds and the nucleus fragmentation. Phacoemulsification of the nucleus and aspiration of the cortex were performed with the Alcon Centurion Vision System and monofocal, toric and multifocal IOLs were successfully implanted. RESULTS: A continuous, central, curvilinear capsulorhexis was performed in 48 cases, 96% (free-floating capsulotomy). In 2 cases, micro-adhesions were reported and detached with the Utrata forceps. Femtolaser capsulotomy resulted in a complete overlap of the anterior capsule over the IOL optics in all cases. Horizontal decentration was found in 2 cases, 4% and vertical decentration in 1 case, 2%. The main corneal incision was self-sealing in 49 cases, 98%. Sutures were used in 1 case, 2%. The hybrid pattern of nucleus fragmentation was used in 42 cases, 84% and the cylindrical pattern in 8 cases, 16%. The fragmentation was incomplete in one case of white cataract and in one case of traumatic cataract. CONCLUSIONS: The main advantages of femtolaser cataract surgery are standardized corneal incisions, perfectly centered, round capsulorhexis, and lens nucleus fragmentation even in eyes with hard cataracts. The laser precision is due to the real time OCT software programs, which cover the whole anterior segment, up to the posterior lens capsule.

FUCHS ENDOTHELIAL CORNEAL DYSTROPHY: IS FEMTOSECOND LASER-ASSISTED CATARACT SURGERY THE RIGHT APPROACH?

INTRODUCTION: Femtosecond Laser-assisted cataract surgery represents a modern technology that hopes to lower the risk of complications for patients suffering from Fuchs endothelial dystrophy by using a reduced level of energy that causes less damage to the endothelium, the main concern for patients with Fuchs endothelial dystrophy. The femtosecond laser performs 3 important steps in cataract surgery: corneal incisions, capsulorhexis and nucleus fragmentation without intraocular instrument manipulation. PURPOSE: The purpose of this study is to determine the efficiency of Femtosecond Laser-assisted cataract surgery in Fuchs endothelial dystrophy. MATERIAL AND METHODS: 5 patients with 6 eyes underwent cataract surgery assisted by Femtosecond Laser LensX at Laser Optisan Clinic. Corneal changes before and after surgery and cumulative dissipated energy (CDE) were analyzed. RESULTS: Before surgery, our patients presented BCVA between 0.16-0.4, Pachymetry between 450-590 Lm, endothelial cells between 789-2008 mm2. The medium cumulative dissipated energy (CDE) used was 4.58 seconds. After surgery, BCVA improved in all patients and none of them developed corneal decompensation so far. CONCLUSIONS: Femtosecond Laser-assisted cataract surgery represents a safe alternative in patients with Fuchs endothelial dystrophy and has a low risk of corneal decompensation.

PERSISTENT PUPILLARY MEMBRANE OR ACCESSORY IRIS MEMBRANE?.

Frequently, in literature and curent practice, accessory iris membrane (AIM) and persistant pupillary membrane (PPM) are confused. Both AIM and PPM are congenital iris anomalies in which fine or thick iris strands arrise form the collarette and obscure the pupil. AIM, which is also called iris duplication, closely resembles the normal iris tissue in color and thickness and presents a virtual second pseudopupil aperture in the centre while PPM even in its extreme forms presents as a translucent or opaque membranous structure that extends across the pupil and has no pseudopupil. Mydriatiscs, laser treatment or surgery is used to clear the visual axis and optimize visual development. Surgical intervention is reserved for large, dense AIMs and PPMs. Our patient, a 29 year old male, has come with bilateral dense AIM, bilateral compound hyperopic astigmatism, BCVA OD = 0.6, BCVA OS = 0.4, IOP OU = 17 mmHg. To improve the visual acuity of the patient we decided to do a bilateral membranectomy, restoring in this way transparency of the visual axis. After surgery, the visual acuity improved to BCVA OD= 0.8, BCVA OS=0.8.